Left Ventricular Concentric Geometric Patterns Are Associated With Worse Prognosis Among Patients With Type-A Aortic Dissection.

Background This study compared left ventricular (LV) characteristics between patients with type-A and type-B aortic dissection (AD) and evaluated the ability of LV remodeling phenotypes (hypertrophy, concentricity, or geometric patterns) to predict mortality in both AD types. Methods and Results We evaluated 236 patients with type A and 120 patients with type B who had echocardiograms within 60 days before or after AD diagnosis (median [25th, 75th percentiles] time difference between echocardiogram and AD diagnosis=1 [0, 6] days) from 3 centers. Patients were stratified according to LV phenotypes, and early (90-day) and late (1-year) mortality after AD diagnosis were assessed. In adjusted logistic regression analysis, patients with type A had higher and lower odds of concentric and eccentric hypertrophy (odds ratio [OR], 2.56; 95% CI, 1.50-4.36; P<0.001; and OR, 0.55; 95% CI, 0.31-0.97; P=0.039, respectively) than those with type B. Results of multivariable Cox-regression analysis showed that LV remodeling phenotypes were not related to mortality in patients with type B. By contrast, LV concentricity was associated with greater early and late mortality (hazard ratio [HR], 2.22; 95% CI, 1.24-3.96; P=0.007 and HR, 2.06; 95% CI, 1.20-3.54; P=0.009, respectively) in type A. In further analysis considering normal LV geometry as reference, LV concentric remodeling and concentric hypertrophy were associated with early mortality (HR, 7.78; 95% CI, 2.35-25.78; P<0.001 and HR, 4.38; 95% CI, 1.47-13.11; P=0.008, respectively), whereas concentric remodeling was associated with late mortality (HR, 5.40; 95% CI, 1.91-15.26; P<0.001) among patients with type A. Assessment of LV geometric patterns and concentricity provided incremental prognostic value in predicting early and late mortality beyond clinical variables in patients with type A based on net reclassification improvement and integrated discrimination improvement. Conclusions LV geometric patterns derived from LV concentricity were associated with greater mortality among patients with type A and may be markers of adverse prognosis in this population.

Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection.

OBJECTIVE: This study compared clinical, echocardiographic, and prognostic characteristics among patients with aortic dissection (AD) with (HypHist) and without (No-HypHist) hypertension history and evaluated the association of blood pressure (BP) at presentation with 1-year mortality, left ventricular (LV) remodeling and renal dysfunction. METHODS: We investigated clinical and echocardiographic characteristics and 1-year mortality among 367 patients with AD (81% HypHist, 66% Type-A) from three Brazilian centers. RESULTS: Patients with No-HypHist were more likely to have Marfan syndrome, bicuspid aortic valve, to undergo surgical therapy, were less likely to have LV hypertrophy and concentricity, and had similar mortality compared with HypHist patients. Adjusted restricted cubic spline analysis showed that systolic BP (SBP) and diastolic BP (DBP) at presentation had a J-curve association with mortality among patients with No-HypHist, but did not associate with death among patients with HypHist (p for interaction = 0.001 for SBP and = 0.022 for DBP). Conversely, the association between SBP at presentation and mortality was influenced by previous use of antihypertensive medications in the HypHist group (p for interaction = 0.002). Results of multivariable logistic regression analysis comprising the whole sample showed direct associations of SBP and DBP at presentation with LV hypertrophy (p = 0.009) and LV concentricity (p = 0.015), respectively, and an inverse association between pulse pressure at presentation and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (p = 0.008). CONCLUSION: Combined information on BP at presentation, previous diagnosis of hypertension, and use of antihypertensive medications might be useful to predict mortality risk and to estimate extra-aortic end-organ damage among patients with AD.

Could applying gels containing chlorhexidine, epigallocatechin-3-gallate, or proanthocyanidin to control tooth wear progression improve bond strength to eroded dentin?

STATEMENT OF PROBLEM: A consensus on whether or how to treat eroded dentin to bond to composite resins is lacking. The role of gels containing chlorhexidine (CHX), epigallocatechin-3-gallate (EGCG), and proanthocyanidin (PAC) in controlling erosive wear progression needs to be evaluated for bonding. PURPOSE: The purpose of this in vitro study was to evaluate the effect of gels containing antiproteolytic agents (CHX or EGCG) or an antiproteolytic and also collagen crosslinking agent (PAC) to control tooth wear progression on the microtensile bond strength (µTBS) of an adhesive system plus a composite resin to simulated eroded dentin. MATERIAL AND METHODS: Superficial occlusal dentin surfaces obtained from sectioned third molars were ground with SiC paper (600-grit; 1 minute; N-normal dentin) or subsequently submitted to an initial erosive challenge (Coca-Cola; 5 minutes). They then received one of the following treatments: application of a placebo (P), a 0.12% CHX digluconate, an EGCG at 400 µM, or a 10% PAC gel (vehicle: hydroxyethylcellulose, propylene glycol, methylparaben, imidazolidinyl urea, and deionized water; active principle: as per the experimental groups when applicable) or no treatment (C: control). Initially demineralized dentin was also submitted to pH cycling (Coca-Cola; 5 minutes, 3×/day, 5 days) to simulate eroded dentin (E). After acid etching all the specimens, adhesive Adper Single Bond 2 was applied, and composite resin (Filtek Z350 XT) was placed. After 24 hours storage in distilled water at 37 °C, the specimens were sectioned into beams, and the µTBS was tested at 0.5 mm/minute. The µTBS values obtained were evaluated considering each tooth as an experimental unit, and 2-way ANOVA and the Tukey post hoc test for multiple comparisons were applied (α=.05). RESULTS: Immediate µTBS values for the eroded dentin were always lower than those for the normal dentin, irrespective of whether any of the gels were applied for wear control. CONCLUSIONS: CHX, EGCG, PAC, and placebo gels, applied after the initial demineralization and before the pH cycling to simulate the eroded dentin, had a similar effect on the µTBS of the adhesive system plus the composite resin to simulated eroded dentin when compared with nonapplication (control).

Anxiety and depression in family members of people hospitalized in an intensive care unit / Ansiedade e depressão em familiares de pessoas internadas em terapia intensiva / Ansiedad y depresión en familiares de personas ingresadas en terapia intensiva

This is a cross-sectional study that aimed to analyze the prevalence of anxiety and depression in the relatives of people hospitalized in an intensive care unit and associated factors. The sample consisted of 135 family members of hospitalized adults in the interior of Bahia. The sociodemographic data sheet and the Hospital Anxiety and Depression Scale were applied. Concerning anxiety, 39.3% presented the symptoms and 28.9% of the relatives had symptoms of depression. According to the logistic regression model, being familiar with less than 40 years of age (OR 2.20, CI 1.049-4.6540, p = 0.037) and living with the relative hospitalized (OR 2.37, CI 1.121-5.024, p = 0.024) was associated with the presence of anxiety symptoms. As for depression, the degree of kinship was associated (OR 2.52, CI 1.096-5.814, p = 0.003). The results reinforce the evidence of association between the hospitalization process and the mental state of the family.

Estudo transversal que objetivou analisar a prevalência de ansiedade e depressão em familiares de pessoas internadas em unidade de terapia intensiva, bem como os fatores associados. Participaram 135 familiares de pessoas adultas, hospitalizadas no interior da Bahia. Foram aplicadas as fichas de dados sociodemográficos e a Escala de Hospitalar de Ansiedade e Depressão. Dos familiares participantes, 39,3% apresentaram sintomas de ansiedade e 28,9%, sintomas de depressão. Segundo o modelo de regressão logística, ser familiar com idade inferior a 40 anos (OR 2,20, IC 1,049-4,6540, p = 0,037) e morar com o parente internado (OR 2,37, IC 1,121- 5,024, p = 0,024) pode ser associado à presença de sintomas de ansiedade. Quanto à depressão, a prevalência está associada ao grau de parentesco (OR 2,52, IC 1,096- 5,814, p = 0,003). Os resultados reforçam as evidências de associação entre o processo de hospitalização e o estado de saúde mental da família.

Estudio transversal que objetivó analizar la presencia de ansiedad y depresión en familiares de personas internadas en unidad de terapia intensiva y los factores asociados. Participaron 135 familiares de personas hospitalizadas en el interior de Bahía. Se aplicaron la ficha de datos socio demográficos y la Escala de Hospitalar de Ansiedad y Depresión. En relación a la ansiedad, el 39,3% presentó y el 28,9% de los familiares tuvieron síntomas de depresión. Enel modelo de regresión logística, ser familiar con edad inferior a 40 años (OR 2,20, IC 1,049-4,6540, p = 0,037) y vivir con el pariente internado (OR 2,37, IC 1,121-5,024, p = 0,024) se asoció la presencia de síntomas de ansiedad. Cuanto a la depresión, estuvo asociado el grado de parentesco (OR 2,52, IC 1,096-5,814, p = 0,003). Los resultados refuerzan las evidencias de asociación entre el proceso de hospitalización y el estado de salud mental de la familia.

Raman spectroscopy with a 1064-nm wavelength laser as a potential molecular tool for prostate cancer diagnosis: a pilot study.

Raman spectroscopy is widely used to investigate the structure and property of the molecules from their vibrational transitions and may allow for the diagnosis of cancer in a fast, objective, and nondestructive manner. This experimental study aims to propose the use of the 1064-nm wavelength laser in a Raman spectroscopy and to evaluate its discrimination capability in prostate cancer diagnosis. Seventy-four spectra from patients who underwent radical prostatectomy were evaluated. The acquired signals were filtered, normalized, and corrected for possible oscillations in the laser intensity and fluorescence effects. Wilcoxon tests revealed significant differences between the benign and malign samples associated with the deformation vibration characteristic of nucleic acids, proteins, and lipids. A classifier based on support vector machines was able to predict the Gleason scores of the samples with 95% of accuracy, opening a perspective for the use of the 1064-nm excitatory wavelength in prostatic cancer diagnosis.

Detection of four regulated grapevine viruses in a qualitative, single tube real-time PCR with melting curve analysis.

The detection of the four grapevine viruses (GLRaV-1, GLRaV-3, GFLV and ArMV) regulated in European Union plant material certification, requires sensitive and specific diagnostic tools. A strategy of simultaneous detection in a real-time single tube amplification was developed, based on the EvaGreen binding dye. The melting curve analysis (MCA) of the amplicons allows a qualitative detection of the four different virus targets in multiplex analysis. A plasmid dilution assay calculated an analytical sensitivity with an amplification threshold up to 100 copies of the target sequences. A small cohort of field grapevine samples, with a known status of infection by mixtures of the target viruses or free of them, respectively, was successfully tested for the evaluation of the amplicons Tm.

Estatinas na doença renal crônica / Statins in chronic renal disease

Hipertrigliceridemia e o HDL baixo são aspectos comuns em pacientes com insuficiência renal crônica. A mortalidade cardiovascular está substancialmente aumentada na presença de doença renal crônica (10-20 vezes maior). Existem evidências de estudos clínicos com estatinas sugerindo uma ação protetora dessas drogas na progressão da doença renal. Além disso, pacientes pós-transplante renal recebendo fluvastatina, experimentaram redução na incidência de infartos não fatais e de mortalidade cardíaca. Entretanto, um estudo recente com atorvastatina não demonstrou reduções na morbi-mortalidade cardiovascular entre pacientes diabéticos em hemodiálise. Estudos em andamento definirão o preciso papel das estatinas neste grupo especial de pacientes.

[Statins in chronic renal disease]. / Estatinas na doença renal crônica.

Hypertriglyceridemia and low HDL-c are common features in patients with chronic renal failure. Cardiovascular mortality is substantially increased in the presence of chronic renal disease (10-20 times higher). There is evidence from clinical trials with statins suggesting their protective role in the progression of renal disease. In addition, reduced rates of non-fatal myocardial infarction and cardiac mortality were seen after renal transplant in patients receiving fluvastatin. However, a recent study with atorvastatin failed to demonstrate reduction in cardiovascular morbidity and mortality among diabetic patients on hemodialysis therapy. Ongoing trials will define the precise role of statins in this subset of patients.

Plasma levels of tumor necrosis factor and endothelial response in patients with chronic arterial obstructive disease or Raynaud's phenomenon.

Tumor necrosis factor alpha (TNF-alpha) is a cytokine that affects endothelial cells' function by changing their antithrombotic potential to a net procoagulant effect. Only a few data have so far been reported for the pathophysiologic role of TNF in vascular diseases in the involvement of microvessels and/or macrovessels and a prothrombotic state. In the present study the authors evaluated plasma TNF (and interleukin-1) levels in 20 patients with chronic arterial obstructive disease (CAOD) with intermittent claudication and 10 CAOD patients with more severe disease (pain at rest/skin ulcers). In addition, they studied 10 patients with Raynaud's phenomenon (RP), suspected to be secondary to a collagen disease. The control group consisted of 20 subjects matched for sex and age with the three groups of patients. TNF levels were assayed by enzyme-linked immunosorbent assay. The antigen levels of von Willebrand factor (vWF), tissue plasminogen activator (t-PA), and its inhibitor (PAI) were also determined as markers of release from the endothelium, while the fragment 1 + 2 of prothrombin (F1 + 2) and thrombin-antithrombin III (TAT) complexes were assessed as indexes of systemic thrombin generation. TNF levels were significantly higher in both groups of CAOD patients than in controls or RP patients, and the same was true for vWF. t-PA was significantly higher only in the CAOD subjects with more severe disease. No differences among groups were seen in PAI antigen/activity or thrombin generation. When data were corrected for age, TNF no longer differentiated CAOD patients from controls and RP subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Platelet and endothelial response with trapidil in patients with peripheral obliterative arteriopathy.

The activity of trapidil, an antiaggregating agent with PDGF antagonist properties, was investigated in order to verify its possible modulating effect in the endothelial and platelet activation. PDGF, t-PA, PAI-1 and ET-1 plasma levels were measured before and after a 2 month treatment period with trapidil 200 mg tablets bid or placebo in 30 patients affected by POA in Fontaine stage II. PDGF and PAI-1 significantly (p < 0.05) increased in the placebo group, and PDGF also in the comparison between treatments (p < 0.05). Aggregation data demonstrate an absence of Ca++ antagonist action of trapidil. The results of this study suggest that trapidil can interfere with the combined vascular and platelet response in atherogenesis.

Platelet-derived growth factor (PDGF) in patients with different degrees of chronic arterial obstructive disease.

Platelet activation and platelet-derived growth factor (PDGF) play a pivotal role in the pathogenesis of atherosclerosis. Evidence has been accumulating that in the evolution of chronic arterial obstructive disease (CAOD) platelets are also crucially important. The aim of the present study was, therefore, to assess plasma levels of PDGF in patients with different degrees of CAOD according to Fontaine. Twenty patients (17 men, 3 women, mean age sixty-eight +/- seven years) with intermittent claudication (Fontaine stage II) entered the study and their PDGF levels were assessed by radioimmunoassay. Ten additional patients (7 men, 3 women, mean age seventy-three +/- seven years) with more severe CAOD (leg pain at rest/skin ulcers) were also studied. Ten healthy subjects (6 men, 4 women, mean age fifty-four +/- six years) comprised the control group. Patients in stage II were reinvestigated after sixty days of a "training" procedure. Patients with both intermittent claudication and more severe disease had higher levels of PDGF than controls (controls 165.9 +/- 119.1 pg/mL; Fontaine stage II 403.5 +/- 218.4; Fontaine stage III/IV 578.1 +/- 637.2: ANOVA P = 0.04) with no difference between the two groups of patients. After the training period, PDGF levels were significantly higher than at baseline (863.7 +/- 819.6 pg/mL vs 403.5 +/- 218.4) but without significant improvement of physical performance. The elevation of PDGF levels in blood from CAOD patients could be the result of marked platelet activation due to interaction with a widely damaged peripheral vasculature. The same was not true for coronary heart disease, in which normal values of PDGF in venous blood were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Need to expand microvascular investigation of patients with Raynaud's phenomenon of different etiology: clinical patterns of 106 consecutive patients.

The differential diagnosis of Raynaud's Phenomenon (RP) is still problematic because of the wide variety of underlying etiological possibilities. Therefore, the diagnostic screening of patients requires easily reproducible, rapid and reliable tests to find those cases of RP secondary to a connective tissue disorder. The present study of 106 consecutive RP patients was carried out by using a combination of clinical examination, biomicroscopy of fingernail folds and bulbar conjunctiva (with scoring of vascular damage), plus the assessment of antinuclear antibodies on HEP2 cells. On the basis of the reported findings, it can be concluded that patients with RP secondary to collagen disease or so suspected also show abnormalities of the conjunctival microcirculatory bed. Patients with both primary and suspected secondary RP are significantly younger at the time of first diagnosis than patients with collagen disease-associated RP.

Deficient fibrinolytic response in patients with Raynaud's phenomenon and its correction with defibrotide.

Twenty outpatients presenting with Raynaud's phenomenon secondary to clinical or preclinical inflammation of connective tissue were treated orally with defibrotide 400 mg three times daily or a matching placebo in a randomized double-blind study. The test product defibrotide (a polydeoxyribonucleic acid compound of animal origin with demonstrated profibrinolytic activity when administered parenterally) was administered orally for 3 weeks in order to explore its effects on the parameters of extrinsic fibrinolysis before and after venous stasis. The antigen of t-PA and its inhibitor PAI, free and total, and the biologic activity of PAI were assayed in basal conditions and after treatment. Although a marked increase of t-PA was seen with the active treatment, PAI activity was significantly reduced by defibrotide. Immunoreactive PAI was not significantly modified by treatment, even though it dropped considerably after venous stasis in the defibrotide group. Thus, the disturbance of endothelial function that seems to occur in vasculitis and in Raynaud's phenomenon secondary to inflammation of connective tissue (or so suspected to be) would constitute the basis of a disturbance of fibrinolysis, which oral defibrotide seems able to correct. Further studies are warranted to define the clinical effectiveness of this treatment in patients with Raynaud's phenomenon.

A new capillaroscopic assessment of microvascular damage vs Maricq classification in patients with isolated Raynaud phenomenon.

A new classification for microvascular lesions assessment by means of capillaroscopy is proposed in this research. The new method, offering a numerical score for microvascular lesions, was used in patients affected by isolated Raynaud Phenomenon (RP). RP can often be associated with scleroderma and, therefore, the new classification has been compared to the Maricq one for what concerns this connective tissue disorder. The numerical method is as sensitive as that by Maricq, but, as easily expected, its specificity is quite low. It appeared to be satisfactory also the positive predictive value of the new capillaroscopy classification combination with the clinical examination and with the immunologic biohumoral investigation. It is particularly easy to apply this method, as it presents to the examinator a restricted range of answers, for the capillaroscopic picture description, but it needs further studies in different microcirculation damages to be proved definitely valuable.